SETON HALL HEALTH LAW CENTER OF EXCELLENCE AWARDED GRANT BY ROBERT WOOD JOHNSON FOUNDATION TO ASSESS NEW JERSEY’S IMPLEMENTATION OF THE AFFORDABLE CARE ACT
Study will measure how effectively New Jerseyans enrolled in individual and small group coverage can access ‘Essential Health Benefits’ as mandated by health reform act
Newark – The Seton Hall Law Center for Health & Pharmaceutical Law & Policy was awarded a grant by the Robert Wood Johnson Foundation to assess how effectively health insurers in New Jersey are delivering mandated essential health benefits to consumers under the Affordable Care Act (ACA).
“The Sentinel Project is designed to create a ‘feedback loop’ between healthcare providers and patients, on the one hand, and insurance plans, government regulators, and the public, on the other,” stated Professor John V. Jacobi, Dorothea Dix Chair of Health Law & Policy and faculty director of the Seton Hall Law Center for Health & Pharmaceutical Law & Policy, who serves as the Project leader.
The passage of the ACA was driven by two goals: to expand health insurance coverage and to ensure that health insurance plans provide consumers with a defined level of “essential health benefits.” The Sentinel Project will use individual advocacy and broad-based information gathering and analysis to call attention to areas in which New Jersey health insurers fall short of the ACA standards and to develop recommendations to bring the plans and services into compliance.
Under the guidance of experienced litigator Renee Steinhagen of New Jersey Appleseed Public Interest Law Center, Seton Hall Law students will assist consumers who enroll in individual or small business health insurance plans but are not able to get the health care they need. This could be because of an outright denial of an insurance claim or because an inadequate network of providers results in them having to wait for long periods or travel long distances for health care. The students will offer services ranging from informal advice to direct representation in health insurance appeals.
Professor Jacobi and his team will gather and analyze data from the individuals assisted by the Project, as well as from the New Jersey Department of Banking and Insurance, from the Federally-Facilitated Marketplace – which operates in states like New Jersey that have chosen not to create their own health insurance exchange – from community education and public policy organizations, from healthcare providers, and from insurers. “In doing so, we will pinpoint lapses and problems,” said Professor Jacobi, “but we also hope to extract best practices when we find circumstances in which the health plans are administered successfully so we may replicate those findings in other parts of the state.”
Kathleen M. Boozang, Associate Dean for Strategic Advancement and the leader of the Center for Health & Pharmaceutical Law & Policy, commented that the Sentinel Project reflects the shared objective of both the Robert Wood Johnson Foundation and Seton Hall Law to secure access to high-quality affordable health care for all.
“As healthcare reform is only in its fledgling stages, the Sentinel Project provides a way forward for implementing the ACA effectively in our state,” she said. “Seton Hall Law has a longstanding tradition of utilizing a clinical model that offers individual advocacy on behalf of underrepresented members of the community. These services provided by the Project, combined with research and monitoring, will both encourage compliance with the law, and more critically, help improve access to healthcare for consumers in New Jersey.”
To date, much of the media focus surrounding the ACA has been on issues and challenges related to enrolling people in health insurance plans. “The ACA’s benefits are achieved not upon enrollment, but upon the connection of enrolled consumers with necessary health benefits,” Professor Jacobi said. He concluded, “It would be a Pyrrhic victory to enroll millions of consumers and fail to connect them to quality care.”
Consumers who believe that they may have been denied coverage by their individual or small group plan can contact the Sentinel Project by email at firstname.lastname@example.org, or by leaving a message at 973-991-1190.
Founded in 1951, Seton Hall University School of Law, New Jersey’s only private law school and a leading law school in the New York metropolitan area, is dedicated to excellence in teaching and in preparing students for the practice of law. The Center for Health & Pharmaceutical Law & Policy exists primarily to educate lawyers and health care industry professionals regarding the extraordinarily complex set of laws that govern patients, health care providers, manufacturers and suppliers. Furthermore, Center faculty and researchers produce scholarship and recommendations for policy on the varied and complex issues posed by health and pharmaceutical law. The Center fosters informed dialogue among policymakers, consumer advocates, the medical profession and industry in the search for solutions to the ethical, legal, and social questions presented in the health and pharmaceutical arena. As part of its educational mission, the Center is a leader in providing compliance education and training on the wide-ranging state, federal, and international mandates that apply to the development, safety, use and promotion of drugs and devices. For more information, visit law.shu.edu.